Post op recovery at home. What to expect...

[nicolegn7]

One of the things which has suprised me about my surgery in Bangkok was the limited amount of information about how the body heals and changes over time, and what to expect and when. This has perhaps been the most difficult phase as things happen but without a nurse or doctor to ask you are left with a feeling of "is this correct?" And "should i send another email to the clinic..."

So rather than starting a thread of competiton about your speed of recovery, i felt it would be a good idea to provide some insights into what has happened to each of us, And what can be done to help each other. Obviously more detailed questions will be necessary, but it should help those thinking and planning their SRS trip, especially if traveling abroad.

Traveling home from SRS with Dr Chettawut in Bangkok was an amazing experience, and is detailed in other threads. Getting back into daily life of dilation at home, cooking and eating for yourself, and trying to take time to relax... Or in my case doing too much because of sorting things at home... And not deeply relaxing enough until the body says enough.

Quick note: soul source dilator sizing are not the same as Dr Chettawuts. His #3 is the same as their #1.

How often to dilate?
Good question. In Bangkok I was dilating three times a day for the first few weeks, and then down to two sessions of one hour (#1 and #2) for the last week... But i felt that things were getting tight and so upon my return home i switched back to 3 times a day, in preparation for moving onto the next size (#3). This was really useful as it made each session slightly shorter, and the dilators came in easier...

Changing up a dilator
Take your time... The most important phrase from the surgeon and also echoed by my gynocologist (who runs a trans clinic). If the muscles are tight do not force them. Just slowly work with your body until you find a way to alow the next size to enter. And do not try to force it to full depth the first few timess!

In my case three times a day i used #1 for 10-15 minutes, #2 for 20-30 minutes and then introduced #3 for 10 minutes at a comfortable depth. This slowly increased to 10-25-25 minutes with about 5 minutes to lube up the new dilator. All told each session takes about 80-90 minutes by the time you also prepare yourself and clean up afterwards.

After a few days i found that #3 would slide to a depth slightly less (by about 1cm) than the others, and pushing more was painful. So stop! It also makes sense as the stretched skin / deformed tissues have to accomodate a dilator with larger volume so some depth may be lost.

Note: you will probably bleed in the first few days. This is normal, but also make sure to look inside your vulva to see if there are any tears in the tissues, especially on the entrance. Once the stitches start disolving the skin may not have healed enough. If this is the case try to clean the wound, let it regularly get some air, and discuss with your doctor about suitable healing creams. I tried using savlon (antiseptic cream) but this was not strong enough to stimulate skin growth... And my gyno recommended lalugen which is having a positive effect.

Note 2: keep an eye out for infections - mucus - especially if you have small external tears. This can slow down your healing or provide complications.

When to change to two dilations a day
We all want to get back to work quickly dont we... And recover those lost hours around lunchtime. This will be very much dependant upon how well you recover, but be guided by your body. If you find the dilator sticking too easily and there is plenty of lubrication gel, then it probsbly means you need to continue three times a day until it becomes easier. For half of week 6 and 7 i have found that two sessions a day are sufficient....

When to wash the labia folds
During hotel recovery we are recommended to avoid touching the soft tissues of the labia. But we were not told when to start regularly cleaning. From experience now i would say that after the first week at home the tissues are likely to be well enough healed to allow a very light soap to be used on the skin and folds. But be careful not to rub anything, if you see specks of blood stop.

Labia bleeding and erotic dreams
One night i awoke to find the labia folds and cliteral hood bleeding.
https://www.susans.org/forums/index.php/topic,172743.0.html
As the healing has progressed I think I have gained more of an insight. There are deep stitches which hold things in place, and laying on your side can cause an increase in blood pressure and make things bleed. Once slightly better healed i discovered some remains of stitches within the end of the cliteral hood, and these felt sharp to the finger, so were definitely sharp for the soft tissues.

After a silver nitrate experience in week 7 i bled again from a similar area. most likely because of straining too much during bowel movements... When the area would already be responding to the silver nitrate with higher blood circulation. Using lalugen cream to helped the healing. However i for two days i had the feeling of walking around with the arousal of the start of an erection, but no trouser snake. Sleeping was interesting as i could feel waves of movement because of over sensitised tissues, at the same time paranoid that the bleeding would return (it didnt fortunately). So at least i know things work. Ahem.

Erotic dreams, as your body is learning about its new changes, can also stimulate excess blood flow. This can in turn cause undue pressure and you may find bleeding occuring. Try not to dream, and try not to worry. If you bleed from these areas regularly then seek advice!

Mucus discharges
Another experience which started a couple of days after the cliteral fold bleeding.
https://www.susans.org/forums/index.php/topic,172946.0.html
Whether the two were related is unknown. However i was stupid enough not to take care quickly, mainly because it didnt seem a problem. I cleaned but carried on dilating and surprise, got the infection into the neo vagina. Which took regular douching with betadine solution to solve (mostly). It also infected a small tear inside the neo vagina which is taking more time to heal...

As soon as you start seeing any form of mucus try to clean with anti bacterial soap, and take care that it does not become a regular problem. Since this can easily spread within a day or two really keep a regular eye on your new skin. Especially if you sweat a lot, or have natural fluids from the tissues.

Urethra opening changes
After the catheter is removed you find your pee aim to be rather everywhere... Which is normal. Sometimes you can guide it to the right place by leaning forwards whilst keeping lumbar spine straight (not hunching). However as time passed i noticed that the surgeon had left a longer tube of the urethra which ran under the labia folds... Which had been kept in place with stitches. Over time ths piece of external tissue has bled and torn lightly until morning after my silver nitrate experience i noticed it had gone... And peeing was much better aim. There is still a lot of blood red spongy tissues which is by design to mimic a more natural woman. Of couse these changes will also be accompanied by blood, especialy when wiping yourseld clean. And also provide another opportunity for infection risk. I have sent a photo to Dr Chettawut who confirmed that everything looks like it is healling well.

Black / blood blisters
This has been my latest little escapade. I woke one morning to find a small black blood blister in the scar tissue on the perenium. It was accompanied by being very sore and uncomfortable. If this happens to you get it checked as soon as possible. Sore Black spots can be a sign of deep bacterial infection.

In my case it seems (cross fingers) to have been a small abscess which oozed a little dark water and blood. A few hours later my doctor checked it, probably a hair or healing issue, and gave antibacterial cream. It naturally popped later in the afternoon and went a more normal pink, but still oozes a little.

Douching
The clinic had recommended waiting two full weeks after returning before douching, and then only twice a week with betadine solution. However in my case the infection started just before. But be prepared that if you have tears or skin damage the betadine solution can sting, and be quite aggressive. I used betadine douche after every dilation during the infection but then dropped down to daily.

Speaking with my gyno (who runs a TG clinic including patients from Dr Suporn) he recommended not using betadine, but a more mild Vagoclyss which contains lactic acids as a more natural fungal solution. My GP treating the blister then recommended a sitzbath (sitting bath in a large bowl) with mild betadine. So everyone has their own ideas..

Book a Gynacologist  and doctor for your return
As you probably realised by now the last month has been quite eventful and it has been good having doctors and gynaecologists who have experience with transgender patients. As Mrs Izzy wrote in a different thread, it is really important that you have healthcare professionals around who know what to do. Especially as your neo-vagina is not identical to a cis-female and may need special treatment. Make sure you know, and trust these people before you travel and try to get an appointment with them within the first two weeks of your return. It will really help you relax, especially as you no longer have a daily nurse visiting!


Thats my thoughts for now. It is the end of week 7 post op and I'm sure more healing and recovery will be needed. Especially as my recovery is running in reverse, getting less mobile and much more tired in the past two weeks than in Bangkok. But this is normal, as somehow all the amazing new changes allow a kind of freedom, and then reality returns. Now i sleep much more often during the day and am really grateful for the 8 weeks sick leave.


Big thank you to Madeline B, Jenna and Mrs Izzy who helped me with their kind advice based upon their experiences.

I'll say one thing. I thought coming home was going to be the best but once I was home I missed the hospital since you were on a schedule and they helped you a lot. Dilating was the worst at home. Not painful but it took over my life to the point I was going crazy and had meltdowns! Being bedridden sucked!

[SorchaC]

Having been home now 10 days I am experiencing the same feeling of missing the routine in Bangkok. For me it has been complicated by suffering my first bout of flu for about 10 years which combined with surgical recovery really kicked my backside for a few days over last weekend. I still managed to dilate 3 times a day but the schedule was all over the place. I did start to wonder what I'd let myself in for but resolved not to lose any dilation time in case it led to some laziness where i started thinking oh missing one won't matter because of course the next one will be allot harder. I think Mel was right that we have to just be patient and let our bodies get used to the changes and us get used to our bodies again.

It has taken me a week to get used to number 3 and I have only achieved full depth twice. I now stop about half an inch short as pushing further most days seems to be painful but I am able to get my original depth with numbers 1 and 2 so it's no big deal I don't think ?

I just wanted to leave this experience in case others have similar so they don't feel there's an issue.

Hugs

Sorcha